Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: Surgical outcomes and learning curve analysis

Escobar, Pedro F.; Starks, David; Fader, Amanda N.; Barber, Matthew D.; Rojas-Espalliat, Luis

doi:10.1016/j.ygyno.2010.05.026

Cited by 88 publications

(53 citation statements)

References 12 publications

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“…Contrary to those reports, however, none of our cases was converted because of an intraoperative complication. The risk-reducing LESS study [14] reported no conversions but the fact that this result was confined to a very small study population needs to be also considered. Aside form the low conversion rate, safety of this laparoscopic approach is also supported by the negligible blood loss (<50 mL) in 96.9% of our cases as well as the low overall complication rate.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, learning curve analysis was found independent of the provided second assist, even though standard laparoscopic RRSO represents one of the first surgical procedures performed by our interns. While a 55-minute operation appears longer when compared with the 35 minutes in the case of LESS [14], it is unclear what the difference would be with less experienced surgeons. The only factors that significantly led to prolonged operative time in our study were BMI greater than 30 and the presence of intra-abdominal adhesions.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, Proven germline mutations in BRCA1 or BRCA2 genes in themselves or at least one of their close relatives OR Personal history of breast cancer before the 36th year of age OR Family history of breast and/or ovarian cancer even in the absence of an identifiable mutation with (i) at least two first-degree relatives diagnosed with cancer: at least one with invasive breast cancer before the age of 41 years or ovarian cancer at any age OR (ii) three first-or second-degree relatives from the same lineage diagnosed with breast and/or ovarian cancer at any age data derived from HBOC population are limited to a few studies [10][11][12][13] with relatively small number of patients, mostly of undefined genetic status, and wide variations in their outcomes. The information gap becomes even more apparent with the emergence of minimally invasive alternatives, such as laparoendoscopic single-site surgery (LESS) [14]. According to preliminary data, LESS represents a feasible technique with excellent clinical outcomes and overall low perioperative complication rates, provided that both laparoscopic surgical expertise and optimal instrumentation are available.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

Shoni

May

Vitonis

et al. 2012

ISRN Minimally Invasive Surgery

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Objective. To establish short-term surgical outcomes of three-port laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast-ovarian cancer syndrome (HBOC). Methods. The medical records of all HBOC women that underwent laparoscopic RRSO between January 2001 and December 2010 were retrospectively reviewed. Demographic data, operative details, and short-term surgical outcomes were obtained and subjected to SAS. Statistical univariate and multivariate analyses were performed. Results. 358 patients met study criteria with 277 (77.4%) carrying a documented BRCA mutation. The predominant technique utilized three ports (two 5 mm and one 10/12 mm), a 5 mm laparoscope and a 5 mm Ligasure pulsatile bipolar device. Mean operative time was 58.3 minutes (SD 22.6,, significantly affected by BMI greater than 30 (P < 0.0001) and status of adhesions (P = 0.001). Estimated blood loss (EBL) was negligible in 96.9% of cases. Seven patients required conversion to laparotomy. No major intraoperative complications were recorded. One-night hospital admission rate was less than 2.0% while postoperative complication rate was 3.1%. Malignancy was revealed in 14 patients (3.9%). Conclusion. In HBOC population, three-port laparoscopic RRSO is a simple, reproducible, and safe procedure with low conversion rate, short operative time, minimal EBL, low surgical morbidity, and rapid postoperative recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

Shoni

May

Vitonis

et al. 2012

ISRN Minimally Invasive Surgery

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“…The benefits of laparoscopic RRSO are reduced invasiveness, a lower rate of postoperative complications and a shorter median hospital stay compared to laparotomy, although laparoscopy may be converted to laparotomy in case of a major intraoperative complication, such as adhesion or perforation (25). Over the last few years, laparoscopic single-port RRSO has been introduced and this procedure has the advantage of further decreased invasiveness compared to conventional laparoscopy (26). Occult cancers are detected at a frequency of 1-4% in cases in which RRSO is performed; thus, both the ovaries and Fallopian tubes should be removed (27,28).…”

Section: Techniques Of Rrsmentioning

confidence: 99%

Risk-reducing surgery in hereditary gynecological cancer: Clinical applications in Lynch syndrome and hereditary breast and ovarian cancer

Adachi

Banno

Yanokura

et al. 2014

Molecular and Clinical Oncology

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Abstract. Risk-reducing surgery (RRS) is defined as a prophylactic approach with removal of organs at high risk of developing cancer, which is performed in cases without lesions or absence of clinically significant lesions. Hereditary gynecological cancers for which RRS is performed include hereditary breast and ovarian cancer (HBOC) and Lynch syndrome. For HBOC, RRS in the United States (US) is recommended for women with mutations in the breast cancer susceptibility (BRCA)1 and BRCA2 genes and bilateral salpingo-oophorectomy (BSO) is generally performed. This procedure may reduce the risk of breast, ovarian, Fallopian tube and primary peritoneal cancer, although ovarian deficiency symptoms occur postoperatively. For Lynch syndrome, RRS in the US is considered for postmenopausal women or for women who do not desire to bear children and BSO and hysterectomy are usually performed. This approach may reduce the risk of endometrial and ovarian cancer, although ovarian deficiency symptoms also occur. For RRS, there are several issues that must be addressed to reduce the risk of cancer development in patients with HBOC or Lynch syndrome. To the best of our knowledge, this is the first review to discuss RRS with a focus on hereditary gynecological cancer. IntroductionHereditary gynecological cancers include ovarian cancer associated with hereditary breast and ovarian cancer (HBOC); endometrial and ovarian cancer associated with Lynch syndrome; endometrial, cervical and ovarian cancer associated with Peutz-Jeghers syndrome; and ovarian cancer associated with Cowden disease. HBOC is an autosomal dominant hereditary disease that may cause breast, ovarian, Fallopian tube and peritoneal cancer.Mutations of the breast cancer susceptibility (BRCA)1 and BRCA2 genes have been identified in ~8-13% of patients with ovarian cancer (1,2). By the age of 70 years, the estimated risks of developing ovarian cancer are 35-60 and 10-27% in BRCA1 and BRCA2 mutation carriers, respectively (2). The mean ages at diagnosis of ovarian cancer are 54, 62 and 63 years for BRCA1 and BRCA2 mutation carriers and non-carriers, respectively, indicating that BRCA1 mutation carriers are more likely to be affected by ovarian cancer at a younger age (3). Clinicopathologically, the majority of ovarian cancers that are BRCA1/2 mutation-positive are of serous histology and are poorly differentiated (grade 3) stage III-IV tumors, according to the International Federation of Gynecology and Obstetrics (FIGO) staging criteria, as defined in 1988 (4,5). In BRCA1/2 mutation-positive and -negative cases, the rates of serous adenocarcinoma are 63-86 and 57-58%, those of poorly differentiated tumors 68-87 and 48-58% and those of stage III-IV tumors 72-88 and 62-70%, respectively.Lynch syndrome, also referred to as hereditary non-polyposis colorectal cancer, is an autosomal dominant hereditary disease that may lead to colorectal, endometrial, gastric and ovarian cancer. Lynch syndrome is caused by germline mutations in DNA mismatch repair (MMR) genes, which include mu...

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“…A total of 58 patients were evaluated surgical proficiency was possible after 10-15 cases in this study (16). Additionally, for gynecologic cancer operation, lymph node dissection with single-port has been introduced (17).…”

Section: Othersmentioning

confidence: 99%

Single-Port Access Laparoscopic Surgery in Gynecology: Technical Tips

Paek¹,

Kim²

2011

Advanced Gynecologic Endoscopy

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Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: Surgical outcomes and learning curve analysis

Cited by 88 publications

References 12 publications

Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

Risk-reducing surgery in hereditary gynecological cancer: Clinical applications in Lynch syndrome and hereditary breast and ovarian cancer

Single-Port Access Laparoscopic Surgery in Gynecology: Technical Tips

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